‘I hit my head.’ Let’s talk about traumatic brain injury

Head trauma is frequently caused by falls, motor vehicle crashes, assaults, sports or combat injuries, and intentional self-harm. All ages may be at risk, especially children, young adults, and those over age 60. Males in any age group are more vulnerable to suffer a brain injury. It is definitively a common medical problem that, at times, goes unattended.

Dr. Vanessa Padilla is assistant professor and Consultation-Liaison Fellowship Program Director of the Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine.

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Traumatic brain injury (TBI) is a major cause of death and disability in the United States, contributing to about 30 percent of all injury deaths, according to the Centers for Disease Control and Prevention (CDC).

A traumatic brain injury is usually classified as mild, moderate, or severe. Mild cases, at times referred to as “concussion,” may or may not experience loss of consciousness, but can be associated with mild headache, nausea or vomiting, fatigue, problems with speech or sleep, dizziness, blurry vision, increased sensitivity to lights or sounds, and/or problems with concentration.

Some symptoms of mild-to-moderate TBI may be apparent, while others may hide in plain sight. Major common neuropsychiatric effects of severe TBI may include severe changes in mood, personality, and behavior, as well as neurological deficits. There is evidence that repeated or severe traumatic brain injuries might increase the risk of degenerative brain diseases, like dementia.

Physical injuries may occur along with TBI, leading to fractures, scars, burns, disfigurement, seizures, infections, hearing loss, swallowing problems, or limited ability to walk or move. Dealing with chronic medical complications after a traumatic brain injury can increase the emotional burden of any individual. Not only can individuals be impacted by the physical and emotional consequences of TBI, but families and entire communities are also affected. Depending on the severity of the brain injury, survivors may face challenges at work or at home. Relationship changes or financial issues may add to the burden during or after the recovery period.

Recovery can feel like a “roller coaster” for some survivors. Physical, emotional and neurological recovery may take them weeks, months, or even years. The more time it takes for the brain to recover, the more likely it is for the brain to recover slowly or incompletely. Given all the brain changes that can occur, healthcare providers prefer to refer to TBI as a disease, rather than an event.

Neuropsychological and psychiatric interventions, support groups, and physical rehabilitation are essential to facilitate recovery and improve quality of life. Understanding the severity of TBI, establishing goals, and following medical and psychiatric treatment recommendations are important elements of rehabilitation. Moreover, preventing or reducing the risk of repetitive brain injuries can be maximized by proper use of seat belts, child safety seats or boosters, by avoiding distractions while driving (i.e. texting), by not driving under the influence of alcohol, drugs or sedating medications, by wearing helmets when practicing sports, by installing and using handrails, and by removing rugs or clutter. Exercising regularly can help with balance and gait, leading to a decrease in the risk of falls.

There are resources available for traumatic brain injury survivors. The Brain Injury Association of America (BIAA) is a great resource of support for families and individuals living with traumatic brain injury. Their 2018-20 “Change Your Mind” campaign raises public awareness by advocating and educating the public about brain injuries, while reducing stigma and empowering survivors.

Any head injury, even if it is mild and non-threatening, is still a serious injury and should be carefully evaluated by a healthcare professional. Ask your doctor or psychiatrist if you have questions or symptoms after receiving a blow to your head or body, especially if you notice any mood or behavioral changes.

Dr. Vanessa Padilla is assistant professor and Consultation-Liaison Fellowship Program Director of the Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine. For more information, visit umiamihealth.org/psychiatry.